Efficacy of treatment for hyperglycemic crisis in elderly diabetic patients in a day hospital

The purpose of this prospective cohort study was to compare the costs of day hospital (DH) care for hyperglycemic crisis in elderly diabetic patients with those of conventional hospitalization (CH). Secondary objectives were to compare these two clinical scenarios in terms of glycemic control, number of emergency and outpatient visits, readmissions, hypoglycemic episodes, and nosocomial morbidity. The study population comprised diabetic patients aged >74 years consecutively admitted to a tertiary teaching hospital in Spain for hyperglycemic crisis (sustained hyperglycemia [>300 mg/dL] for at least 3 days with or without ketosis). The patients were assigned to DH or CH care according to time of admission and were followed for 6 months after discharge. Exclusion criteria were ketoacidosis, hyperosmolar crisis, hemodynamic instability, severe intercurrent illness, social deprivation, or Katz index >D. Sixty-four diabetic patients on DH care and 36 on CH care were included, with no differences in baseline characteristics. The average cost per patient was 1,345.1±793.6 € in the DH group and 2,212.4±982.5 € in the CH group (P <0.001). There were no differences in number of subjects with mild hypoglycemia during follow-up (45.3% DH versus 33.3% CH, P =0.24), nor in the percentage of patients achieving a glycated hemoglobin (HbA) <8% (67.2% DH versus 58.3% CH, P =0.375). Readmissions for hyperglycemic crisis and pressure ulcer rates were significantly higher in the CH group. DH care for hyperglycemic crises is more cost-effective than CH care, with a net saving of 1,418.4 € per case, lower number of readmissions and pressure ulcer rates, and similar short-term glycemic control and hypoglycemia rates

New ammonia lyases and amine transaminases: Standardization of production process and preparation of immobilized biocatalysts

Background: New enzymes for biotransformations can be obtained by different approaches including directed mutagenesis and in vitro evolution. These mutants have to be efficiently produced for laboratory research on bioreactions as well as for process development. In the framework of a European ERA-IB project, two different types of enzymes (ammonia lyases and aminotransferases) have been selected as biocatalysts for the synthesis of industrially relevant amines. New mutant enzymes have been obtained: a) aspartases able to recognize \u3b2-amino acids; b) \u3c9-transaminases with improved activity. The objectives are to find out a common operational strategy applicable to different mutants expressed in E. coli with the same initial genetic background, the development of an integrated process for production and the preparation of stable useful biocatalysts. Results: Mutant enzymes were expressed in E. coli BL21 under the control of isopropylthiogalactoside (IPTG) inducible promoter. The microorganisms were grown in a formulated defined medium and a high-cell density culture process was set up. Fed-batch operation at constant specific growth rate, employing an exponential addition profile allowed high biomass concentrations. The same operational strategy was applied for different mutants of both aspartase and transaminase enzymes, and the results have shown a common area of satisfactory operation for maximum production at low inducer concentration, around 2 \u3bcmol IPTG/g DCW. The operational strategy was validated with new mutants and high-cell density cultures were performed for efficient production. Suitable biocatalysts were prepared after recovery of the enzymes. The obtained aspartase was immobilized by covalent attachment on MANA-agarose, while \u3c9-transaminase biocatalysts were prepared by entrapping whole cells and partially purified enzyme onto Lentikats (polyvinyl alcohol gel lens-shaped particles). Conclusions: The possibility of expressing different mutant enzymes under similar operation conditions has been demonstrated. The process was standardized for production of new aspartases with \u3b2-amino acid selectivity and new \u3c9-transaminases with improved substrate acceptance. A whole process including production, cell disruption and partial purification was set up. The partially purified enzymes were immobilized and employed as stable biocatalysts in the synthesis of chiral amines

Prevalencia y características de la depresión mayor y la distimia en atención primaria

ObjetivoConocer la prevalencia y características de los trastornos depresivos en pacientes que consultan en atención primaria.DiseñoEstudio descriptivo, transversal. Dos fases, en la primera cribado y en la segunda entrevista psiquiátrica estructurada.EmplazamientoOcho consultas en 4 centros de atención primaria.Pacientes y métodosUna muestra de 350 pacientes consecutivos de 18-70 años cumplimentó el Zung's Self-Rating Depression Scale (SDS). En los 138 con resultado positivo y en 67 con resultado negativo se investigaron los diagnósticos de «episodio depresivo mayor» y «distimia» mediante la Structured Clinical Interview for DSM-IV Axis I Disorders.Mediciones y resultados principalesHallamos una prevalencia ponderada del 14,7% (IC del 95%, 10,7-18,7%) para depresión mayor y del 4,6% (IC del 95%, 2,4-6,8%) para distimia. La puntuación media en el SDS fue 65,6 (DE, 11,6) en el grupo con depresión mayor y de 63,3 (DE, 8,7) en el grupo con distimia.La puntuación media en los no deprimidos fue de 44,2 (DE, 8,7), menor a las de ambos grupos de deprimidos (p < 0,0001).El género femenino distinguió a los grupos de deprimidos del grupo no deprimido. El menor nivel educativo y la proporción de hiperfrecuentadores distinguieron al grupo con depresión mayor del no deprimido.Los perfiles sintomáticos fueron virtualmente idénticos entre los 2 grupos deprimidos, mientras que en la mayoría de los síntomas explorados la frecuencia de presentación difería significativamente entre los deprimidos y los no deprimidos.ConclusionesDepresión mayor y distimia presentan una alta prevalencia en los pacientes de atención primaria en nuestro medio. Ambos trastornos presentan características comunes en variables demográficas y perfil sintomático.ObjectiveTo find the prevalence and characteristics of depressive disorders in patients consulting in primary care.DesignCross-sectional descriptive study. Two stages: screening, then structured psychiatric interview.SettingEight clinics at four primary care centres.Patients and methodsA sample of 350 consecutive patients aged between 18 and 70 filled out Zung's Self-Rating Depression Scale (SDS). The diagnoses of major depressive episode and dysthymia for the 138 with positive result and the 67 with negative result were investigated through the Structured Clinical Interview for DSM-IV Axis I Disorders.Measurements and main resultsWe found a weighted prevalence of 14.7% (95% CI: 10.7-18.7) for major depression and 4.6% (95% CI: 2.4-6.8) for dysthymia. Mean score on the SDS was 65.6 (SD 11.6) in the group with major depression and 63.3 (SD 8.7) in the group with dysthymia. Mean score in the not-depressed group was 44.2 (SD 8.7), lower than the scores for both groups with depression (p < 0.0001). Being female distinguished the depressed groups from the not-depressed group. Lower educational level and the amount of over-users distinguished the group with major depression from the not-depressed group. The symptom profiles were virtually identical for the two depressed groups, whereas the frequency of occurrence of most of the symptoms explored differed significantly between those with and without depression.ConclusionsPrevalence of major depression and dysthymia are high in primary care patients in our area. Both disorders have common characteristics of demographic variables and symptom profile

Efficacy of treatment for hyperglycemic crisis in elderly diabetic patients in a day hospital

D Benaiges,1&ndash;3 JJ Chillar&oacute;n,1&ndash;3 MJ Carrera,1,3 F Cots,3,4 J Puig de Dou,1 E Corominas,1 J Pedro-Botet,1&ndash;3 JA Flores-Le Roux,1&ndash;3 C Claret,1 A Goday,1&ndash;3 JF Cano1&ndash;3 1Department of Endocrinology and Nutrition, Hospital del Mar, 2Department of Medicine, Universitat Aut&ograve;noma de Barcelona, 3Institut Hospital del Mar d&rsquo;Investigacions M&egrave;diques, 4Epidemiology and Evaluation Department, Parc de Salut Mar, Barcelona, Spain Background:&nbsp;The purpose of this prospective cohort study was to compare the costs of&nbsp;day hospital (DH) care for hyperglycemic crisis in elderly diabetic patients with those of conventional hospitalization (CH). Secondary objectives were to compare these two clinical scenarios in terms of glycemic control, number of emergency and outpatient visits, readmissions, hypoglycemic episodes, and nosocomial morbidity. Methods: The study population comprised diabetic patients aged &gt;74&nbsp;years consecutively admitted to a tertiary teaching hospital in Spain for hyperglycemic crisis (sustained hyperglycemia [&gt;300&nbsp;mg/dL] for at least&nbsp;3&nbsp;days with or without ketosis). The patients were assigned to DH or CH care according to time of admission and were followed for&nbsp;6&nbsp;months after discharge. Exclusion criteria were ketoacidosis, hyperosmolar crisis, hemodynamic instability, severe intercurrent illness, social deprivation, or Katz index &gt;D.Results: Sixty-four diabetic patients on DH care and&nbsp;36&nbsp;on CH care were included, with no differences in baseline characteristics. The average cost per patient was&nbsp;1,345.1&plusmn;793.6&nbsp;&euro; in the DH group and&nbsp;2,212.4&plusmn;982.5&nbsp;&euro; in the CH group (P&lt;0.001). There were no differences in number of subjects with mild hypoglycemia during follow-up (45.3% DH versus&nbsp;33.3% CH, P=0.24), nor in the percentage of patients achieving a glycated hemoglobin (HbA1c) &lt;8% (67.2% DH versus&nbsp;58.3% CH, P=0.375). Readmissions for hyperglycemic crisis and pressure ulcer rates were significantly higher in the CH group.Conclusion: DH care for hyperglycemic crises is more cost-effective than CH care, with a net saving of&nbsp;1,418.4&nbsp;&euro; per case, lower number of readmissions and pressure ulcer rates, and similar short-term glycemic control and hypoglycemia rates. Keywords: day hospital, conventional hospitalization, hyperglycemic crisi

Efficacy of treatment for hyperglycemic crisis in elderly diabetic patients in a day hospital

The purpose of this prospective cohort study was to compare the costs of day hospital (DH) care for hyperglycemic crisis in elderly diabetic patients with those of conventional hospitalization (CH). Secondary objectives were to compare these two clinical scenarios in terms of glycemic control, number of emergency and outpatient visits, readmissions, hypoglycemic episodes, and nosocomial morbidity. The study population comprised diabetic patients aged >74 years consecutively admitted to a tertiary teaching hospital in Spain for hyperglycemic crisis (sustained hyperglycemia [>300 mg/dL] for at least 3 days with or without ketosis). The patients were assigned to DH or CH care according to time of admission and were followed for 6 months after discharge. Exclusion criteria were ketoacidosis, hyperosmolar crisis, hemodynamic instability, severe intercurrent illness, social deprivation, or Katz index >D. Sixty-four diabetic patients on DH care and 36 on CH care were included, with no differences in baseline characteristics. The average cost per patient was 1,345.1±793.6 € in the DH group and 2,212.4±982.5 € in the CH group (P <0.001). There were no differences in number of subjects with mild hypoglycemia during follow-up (45.3% DH versus 33.3% CH, P =0.24), nor in the percentage of patients achieving a glycated hemoglobin (HbA) <8% (67.2% DH versus 58.3% CH, P =0.375). Readmissions for hyperglycemic crisis and pressure ulcer rates were significantly higher in the CH group. DH care for hyperglycemic crises is more cost-effective than CH care, with a net saving of 1,418.4 € per case, lower number of readmissions and pressure ulcer rates, and similar short-term glycemic control and hypoglycemia rates